Surgical instrument



June 15, 1948. A, A. RD 2,443,439.

URGICAL INSTRUMENT Fi l e d 0 c t 3 l 1 9 46 June 15, 1948. A. A. ALFORD SURGICAL INSTRUMENT Filed Oct. 31, 1946 ZSheets-Sheet 2 /n ven for a a ,Q/fO/d Patented June 15, 1948 UNITED sT 'T-ss PATENT? orrlcs 2,443,439 SURGICAL INSTRUMENT 1 Andrew A. Alford, Oakville, Manitoba, Canada Application October 31, 1946, SerialNo. 706,943 2 '7 Claims. (Cl. 128-326) ,My invention relates to surgical instruments, an object being to provide a device of the character herewithin described primarily for use in episiotomies whereby the technique of such operations may be improved by permitting the insertion of sutures prior to making the incision.

Further advantages reside in the fact that, with the use of the herein described instrument, an

episiotomy may be performed in less time than byconventional procedures; the patient is caused stretching and bruising of tissue is avoided by the.

earlier performance of the operation; post delivery anaesthetic is rendered unnecessary since the sutures are already inserted, with local or general anaesthesia. I

With the foregoing objects in view, and such other objects and advantages as will become apparent to those skilled in the art to which this invention relates as this specification proceeds, my invention consists essentially in the arrangement and construction of parts all as hereinafter more particularly described, reference being had to the accompanying drawings, in which- Figure 1 is a front view of my surgical instrument.

Figure 2 is a view of my instrument taken at right angles to Figure 1.

Figure 3 is a section on the line 3-3 of Figure 2.

Figure 4 is an anatomical representation illustrating my instrument in situ for a medic-lateral episiotomy with the sutures inserted and in readiness for the making of the incision, a portion of this representation beingshown in fragmentary form to illustrate the end of my instrument remote from the handle in full line.

Figure 5 is a representation similar to Figure 4 but a little later in the stage of labor, and wherein the incision has been made and my instrument withdrawn together with the suturing thread prior to release of the suturing thread from the instrument.

Figure 6 is an anatomical representation of a modified form of my instrument in situ for the performance of a medial episiotomy with lateral extension, the suturing threads in this view being shown inserted ready for the making of the necessary incision where indicated in dotted lines.

In the drawings like characters of reference indicate corresponding parts in the different figures.

The standard procedure in the performance of episiotomies consists in making the incision when the tissues are fully stretched and almost at the point of rupture. The incision is made with scissors, and the necessary repair is done and sutures inserted after delivery. This necessitates the administration of post-delivery anaesthetic which increases the risk of haemorrhage.

By contrast, my improved technique is undertaken with the essential aid of the instrument about to bedescribed. Proceeding therefore first to describe my instrument per se the same consists of the following parts in the stated relas tionship:

To a manipulating handle I is secured in coterminous and counter-curving relationship, a shielding element 2, and an elongated, flexible, scalpel and suture guide 3, the latter being transversely concave as best indicated in the accompanying Figure 3 for substantially the length thereof upon what I consider the exterior surface 4. i

The shielding element 2 is of substantially planar transversity, but is longitudinally curved as best illustrated in the accompanying Figure 2.

as is also the guide 3, so that the curvature of the parts 2 and 3 may be considered as approximately parallel.

The parts 2 and 3 are spaced to provide the elongated opening 5, and integral with the end of the guide 3 remote from handle I is a hook 6, the inner end I of which is normally in contact with the adjacent surface of the shielding element 2. The guide 3 is however longitudinally resilient, and hence may be flexed to a limited extent in the direction of arrow 8 whereby hook 6 may be moved away from element 2 for the purpose of releasing suture threads as will be hereinafter described.

Finally in connection with the structure ofmy instrument is to be noted the provision of a small operative-position indicating projection 9 in the form of a blister or nodule.

' Having now described the structure of my surgical instrument, its manner of use will be explained.

At the appropriate time during the period of labor, my instrument is pushed into the passage betweenthe tissues and the head of the infant in anoutward and rearward direction as clearly illustrated in the acompanying Figure 4 and there held firmly in place. Sutures H] are now inserted through the skin and the tissues below adjacent one edge of the suture guide 3, the conventional curved needle carrying the suture through the elongated opening 5 between the guide 3 and the shielding 2, and emerging adjacent the opposite edge of the guide.

The sutures and the instrument may be maintained as described up to this point and as illustrated in the accompanying Figure 4 until it is desired to make the incision indicated in Figure 5, and when the incision has been made, my instrument is withdrawn, at which time the portions of the several sutures extending through the opening 5 accumulate to be intercepted by the hook 6.

Thus the instrument pulls the sutures as clearly indicatedin the accompanying Figure 5 to the extent necessary to provide enough slack thread to accommodate the maximum distension of the I incision during delivery. When sufficient thread has been drawn to provide the necessary slack as exemplified in Figure 5, my instrument will be rotated in an arc to remove the cluster of threads away from the passage of the infant, and it will be readily perceived that the threads may quickly and conveniently be disengaged from the hook of my instrument simply by rotating the instrument parallel with the taut cluster of threads untilthe hook is in such position that the threads will pull off without the necessity for manually flexing the member -3 away from member 2 as indicated by the arrow 8 in Figure 2. Having removed my instrument, it is to be understood that the slack portions of the sutures will thus remain with one or more forceps attached thereto so'that they hang well out of the way until delivery has taken place, after which the sutures willbe drawn tight and tied off to close the incision neatly and cleanly.

From a consideration of the foregoing it will clearly be apparent that the member 3 functions, by virtue of its transverse curvature not only as a guide for the suturing needle, but as a guiding trough for the scalpel, which, together With the shielding element 2 protects the infants head from injury. In the accompanying Figure 6 I have illustrated in situ a modified configuration of my instrument for the performance of medial episiotomies with lateral extensions, and in this case it is to be understood that the incision is sickle shaped as indicated by the dotted lines I I.

It is accordingly to be understood that the instrument I 2 of Figure 6 is similar in all respects to the instrument of Figure 1 excepting for the fact that the shielding element and guide are jogged or offset with respect to the produced axis of the handle, commencing at a point upon the length of the shielding element and guide so that an incision as above described may be made to avoid the anus. After insertion of the instrument, suturing threads are pierced through the adjacent tissues as I have already described.

Since various modifications can be made in my invention as hereinabove described and many apparently widely different embodiments of same made within the spirit and scope of the claims without departing from such spirit and scope, it is intended that all matter contained in the accompanying specification shall be interpreted as illustrative only and not in a limiting sense.

What I claim as my invention is:

1. A surgical instrument for episiotomies and the like comprising in combination an elongated scalpel-and-suture-guide, a shielding element, means for drawing and releasing the sutures after insertion, and a manipulating handle, said guide and shielding element being substantially parallel and spaced between the ends thereof for use in the manner herein specified.

2. The instrument according to claim 1 in which said means for drawing and releasing the sutures consists of a hook at the end of said guide remote from said handle, said hook bridging the space between said guide and shielding element, and means for moving said hook away from said element to allow the passage of suturing thread therepast.

3. The instrument according to claim 1 in which said guide is longitudinally flexible, and in which said means for drawing and releasing sutures consists of a hook secured to the end of said guide remote from said handle, said hook bridging the space between said guide and said shielding element, the flexing of said guide moving said hook away from said element to allow the passage of suturing thread therepast.

4. The instrument according to claim 3 which includes an operative-position indicating projection on the end of said guide for the purpose specified.

5. The instrument according to claim 1 which includes an operative-position indicating projectionon the end of said guide for the purpose herein specified.

6. A surgical instrument for episiotomies and the like comprising in combination an elongated scalpel-andsuture-guide transversely concave upon the exterior surface thereof, a shielding element, means for drawing and releasing the sutures after insertion, a manipulating handle, said guide and shielding element being substantially parallel and spaced and secured at the ends thereof to one end of said handle for use in the manner herein specified, and an operative-position indicating projection on the end of said guide for the purpose herein specified.

'7. A surgical instrument for episiotomies and the like comprising in combination an elongated and longitudinally flexible scalpel-and-sutureguide transversely concave upon the exterior surface thereof, a shielding element, a manipulating handle, said guide and shielding element being substantially parallel, spaced and longitudinally curved, said facing providing an elongated suture inserting opening between, means for drawing sutures after insertion consisting of a hook secured to the end of said guide remote from said handle, and bridging the space between said guide and suturing element, said sutures being releasable from said instrument by flexing said guide to allow the passage of suturing thread past the hook secured thereto.

ANDREW A. ALFORD. 

